Migraines Secondary to Tinnitus

If your tinnitus is service connected and you now have migraines, you can claim the migraines as secondary to the tinnitus. Migraines are one of the conditions veterans most often claim secondary to tinnitus at the Board. The claim is harder than it looks. The research shows the two conditions often occur together, but it does not show which one comes first, and a head injury, a blast or a hearing disorder can explain both. What wins it is a medical opinion that fits your own records.

Can tinnitus cause migraines?

The research shows a clear link between tinnitus and migraine. It does not show that tinnitus causes migraine.

• In a national U.S. survey of 12,962 adults (Goshtasbi and colleagues, Otology & Neurotology, 2021), 34.6% of people with migraine reported tinnitus, against 16.9% of people without migraine. After adjusting for other factors, migraine still went with about twice the odds of tinnitus. Every answer was self-reported, and the authors suggested that effects of migraine on the ear may be part of the link.
• Among 5,729 French university students (Guichard and colleagues, Headache, 2016), migraine went with higher odds of tinnitus (adjusted odds ratio 1.77), most strongly for migraine with aura.
• A 2024 systematic review of six studies with 26,166 participants (Campello and colleagues, International Journal of Audiology) found that most showed an association between migraine and tinnitus. The authors named the small number of studies as a limitation.
• In 193 tinnitus-clinic patients with headaches (Langguth and colleagues, BioMed Research International, 2015), the side of the headache was significantly related to the side of the tinnitus, and in most patients the two rose and fell together. The authors wrote that this argues against a purely coincidental overlap. A follow-up study from the same clinic (Frontiers in Neurology, 2017) read the extra problems in these patients as a sign of "a generally increased amplification of sensory signals in a subset of tinnitus patients with comorbid headaches." A VA physician quoted that sentence in the 2021 Board grant described below.

Two findings cut the other way, and a careful opinion deals with both. A Taiwan insurance-records study (Hwang and colleagues, JAMA Otolaryngology Head and Neck Surgery, 2018) followed 1,056 people with migraine and 4,224 matched people without it, and found that migraine raised the later risk of tinnitus (adjusted hazard ratio 3.30). That points from migraine toward tinnitus. And a 2023 meta-analysis of cohort and case-control studies (Biswas and colleagues, Journal of the Association for Research in Otolaryngology) found no association between migraine and tinnitus risk, though most of its findings pooled four studies or fewer and the authors called them inconclusive.

The research supports a link a doctor can reason from, not cause and effect. The opinion has to rest on your own history: when each condition started, whether your headaches change when the ringing changes, and what else could explain both.

When a head injury or blast explains both

The 2024 VA/DoD tinnitus guideline tells clinicians assessing tinnitus to ask about head or neck injury, blast exposure, noise exposure and hearing problems. The 2023 VA/DoD headache guideline tells clinicians to decide first whether a headache is secondary to another disorder, and it lists headache attributed to trauma or injury to the head or neck among the secondary headaches. If a blast or head injury in service caused both your ringing and your headaches, a direct claim tied to that event, or a claim tied to a service-connected TBI or neck condition, may fit your records better. Ask the doctor which theory the records support.

How VA decides migraines secondary to tinnitus

Secondary service connection is in 38 CFR § 3.310. VA grants it in two ways:

• Caused by. Your service-connected tinnitus caused the migraines, at least as likely as not.
• Aggravated by. Your migraines are aggravated by your service-connected tinnitus, meaning they would be less severe but for the tinnitus (M21-1 V.ii.2.D). VA rates only the part above the baseline, so the opinion should describe the baseline.

If you had headaches before the tinnitus started, the claim is about aggravation, and your earlier headache records set the baseline. The file needs three things: a current migraine or other headache diagnosis, service-connected tinnitus, and a medical opinion that links the two with reasoning.

What the Board did in one grant

In Board citation A21002562 (February 2, 2021), a Marine aircraft mechanic reported tinnitus that began in 2015 on the flight line and migraines that began in 2016. The veteran's treating VA physician wrote that the migraines were "more likely than not being caused by the ongoing tinnitus." A VA nurse practitioner and a VA contract physician agreed, and a VA internal medicine physician supported the link by quoting the 2017 Langguth study above. A VA neurology clinic declined to write a letter. The Board noted gaps, including that the treating physician did not discuss the service treatment records, but found at least an equal balance of evidence that tinnitus caused the headaches, and granted the claim. Board decisions are not precedential, but they show what the Board accepts.

How to prove it: build a tinnitus and headache timeline

The timeline decides whether causation or aggravation fits. Start with the earliest record, even if it differs from your memory, and list with dates:

• each tinnitus record: onset, hearing tests, the rating decision
• each headache record: first complaint, diagnosis, medication changes, emergency or urgent care visits
• any head injury, neck injury or blast exposure
• periods when the ringing got louder, and whether the headaches changed with it
• sleep problems, medications and mental health conditions a doctor will weigh

A headache log kept over several months documents how often your attacks are prostrating, which sets the rating. Statements from people who see your attacks help with both; the buddy letter tool and the personal statement tool can help you write them.

VA rating for migraines secondary to tinnitus

Migraines secondary to tinnitus are rated the same way as any migraines, under Diagnostic Code 8100 in 38 CFR § 4.124a:

• 50%: very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability
• 30%: characteristic prostrating attacks occurring on an average once a month over the last several months
• 10%: characteristic prostrating attacks averaging one in two months over the last several months
• 0%: less frequent attacks

The rating turns on prostrating attacks, not on how many headaches you have. The migraine VA rating page explains what prostrating means and what moves a rating from 30 to 50 percent. If your diagnosis is tension headache or another type with no code of its own, VA may rate it by analogy under the same code (38 CFR § 4.20). If your attacks keep you from holding a job, read the TDIU guide.

VA rates the migraines separately from the tinnitus. Tinnitus carries a single 10 percent rating under Diagnostic Code 6260, whether you hear it in one ear, both ears or your head. The two ratings combine under 38 CFR § 4.25. A 30 percent migraine rating and the 10 percent tinnitus rating combine to 37, which VA rounds to 40 percent. A 50 percent migraine rating and the 10 percent tinnitus rating combine to 55, which VA rounds up to 60 percent.

The C&P exam for migraines secondary to tinnitus

VA usually orders a headache exam, a medical opinion, or both. The examiner is asked whether your migraines are at least as likely as not caused by your tinnitus and, separately, whether the tinnitus aggravated them. Both questions matter. An opinion that answers only the first one is inadequate under El-Amin v. Shinseki (2013).

What the examiner looks at:

• When the tinnitus and the headaches each started, including any headaches in your service treatment records
• Head or neck injury, blast exposure and hearing problems
• Medications, sleep and other conditions that can bring on headaches
• How often your attacks are prostrating and how they affect your work

Unfavorable opinions on this claim usually go wrong in one of three ways. They say no medical literature links tinnitus and migraine, which ignores the studies above. They note the association and stop, without applying your timeline. Or they find that the headaches started first and reject causation without answering aggravation. In the 2021 Board case, the neurology clinic declined to write a letter, but the Board noted that it never addressed causation or aggravation by tinnitus. The C&P exam prep tool can help you get ready to describe your attacks.

Why migraines secondary to tinnitus claims get denied

The usual reasons:

• The only medical opinion is a negative VA opinion, and nothing in the file answers it.
• A private opinion cites the association between tinnitus and migraine but never applies it to your dates and symptoms.
• The records show headaches before the tinnitus, and no opinion addresses aggravation or describes the baseline.
• A head injury, blast exposure or other cause in the file goes unaddressed, so the examiner credits that instead.
• The records describe headaches too vaguely to show a migraine diagnosis or prostrating attacks.

The Board section below breaks down the evidence that decided the grants and the denials.

Nexus letter for migraines secondary to tinnitus

A strong nexus letter for this claim does six things:

1. States that the doctor reviewed your records, including service treatment records, hearing tests and headache treatment.
2. Names the diagnosis: migraine, another headache type, or both.
3. Gives an opinion on causation: your migraines are at least as likely as not caused by your service-connected tinnitus.
4. Gives a separate opinion on aggravation: your migraines are aggravated by your service-connected tinnitus, meaning they would be less severe but for the tinnitus, and describes the baseline before the worsening.
5. Explains the reasoning from your timeline, cites the research, and says what the research does not settle, including the study in which migraine came first.
6. Deals with other causes directly: head or neck injury, blast exposure, medications and sleep problems.

Before you pay for a letter, ask the clinician:

• Is the diagnosis migraine, another headache type, or more than one?
• Does the order of events in my records support tinnitus as a cause, a worsening factor, or neither?
• Could a head or neck injury, a hearing disorder, a sleep problem or a medication better explain the pattern?
• If my headaches came first, would they be less severe today but for the tinnitus, and which records show the earlier level?

A clinician may decide the link is not supportable in your case, and that answer is worth having early. The Raven Nexus tool shows what your hearing and headache records already document and what the opinion still needs to answer.

Where these opinions break down at the Board is predictable: no rationale, a conclusion with no reasoning behind it, an incomplete review of the records, or reasoning that ignores the timeline. The 2021 grant survived an opinion that skipped the service treatment records; a stronger letter avoids that gap.

DBQ for migraines secondary to tinnitus

VA's Headaches (including Migraine Headaches) Disability Benefits Questionnaire, in the version on VA's public DBQ page (updated July 9, 2024), records the facts that set the rating:

• the diagnosis (migraine, tension, cluster or other) and the date of diagnosis
• the history, including onset and course, and any continuous medication
• symptoms such as throbbing pain, nausea and sensitivity to light or sound, and how long a typical attack lasts
• whether you have characteristic prostrating attacks and how often, and whether you have completely prostrating and prolonged attacks and how often
• whether the headaches affect your ability to work

The form defines prostrating as "causing extreme exhaustion, powerlessness, debilitation or incapacitation with substantial inability to engage in ordinary activities." The DBQ does not ask whether tinnitus caused or aggravated your migraines. That goes in a separate medical opinion that answers both questions.

Questions veterans ask about migraines secondary to tinnitus

Can tinnitus cause migraines?

Studies show the two often occur together, and tinnitus-clinic research found that headaches and ringing often worsen and ease together. No study shows that tinnitus causes migraine, so a medical opinion has to apply the research to your own records.

What is the VA rating for migraines secondary to tinnitus?

The same as any migraines under Diagnostic Code 8100: 0, 10, 30 or 50 percent, based on how often prostrating attacks happen. The migraine rating combines with your 10 percent tinnitus rating.

How do I prove migraines secondary to tinnitus?

You need a current headache diagnosis, service-connected tinnitus, and a medical opinion that explains the link from your timeline. Records showing when each condition started and how they changed together give the opinion its footing.

What if my migraines started before my tinnitus?

Then the claim is about aggravation. A doctor has to say the migraines would be less severe but for the tinnitus, and your earlier headache records set the baseline.

What if a head injury caused my tinnitus and my headaches?

Then a direct claim tied to the injury, or a claim secondary to a service-connected TBI, may fit better. Ask the doctor which theory your records support.

Sources

• 38 CFR § 3.310, secondary service connection; M21-1 V.ii.2.D, aggravation of a nonservice-connected disability by a service-connected one.
• 38 CFR § 4.124a, Diagnostic Code 8100, migraine; 38 CFR § 4.20, analogous ratings; 38 CFR § 4.87, Diagnostic Code 6260, tinnitus; 38 CFR § 4.25, combined ratings table.
• El-Amin v. Shinseki, 26 Vet. App. 136 (2013), an opinion must address aggravation.
• Board of Veterans' Appeals citation A21002562 (February 2, 2021, granted). Board decisions are not precedential.
• VA Disability Benefits Questionnaire, Headaches (including Migraine Headaches), updated July 9, 2024.
• VA/DoD Clinical Practice Guideline for Tinnitus, June 2024. VA/DoD Clinical Practice Guideline for the Management of Headache, pocket card, September 2023.
• Goshtasbi K, Abouzari M, Risbud A, et al. Tinnitus and Subjective Hearing Loss are More Common in Migraine: A Cross-Sectional NHANES Analysis. Otology & Neurotology. 2021;42(9):1329-1333. PMID 34238896.
• Guichard E, Montagni I, Tzourio C, Kurth T. Association Between Headaches and Tinnitus in Young Adults: Cross-Sectional Study. Headache. 2016;56(6):987-994. PMID 27197786.
• Campello CP, Lemos CAA, Andrade WTL, et al. Migraine associated with tinnitus and hearing loss in adults: a systematic review. International Journal of Audiology. 2024;63(1):1-7. PMID 36459425.
• Langguth B, Hund V, Busch V, et al. Tinnitus and Headache. BioMed Research International. 2015;2015:797416. PMID 26583133.
• Langguth B, Hund V, Landgrebe M, Schecklmann M. Tinnitus Patients with Comorbid Headaches: The Influence of Headache Type and Laterality on Tinnitus Characteristics. Frontiers in Neurology. 2017;8:440. PMID 28894434.
• Hwang JH, Tsai SJ, Liu TC, Chen YC, Lai JT. Association of Tinnitus and Other Cochlear Disorders With a History of Migraines. JAMA Otolaryngology Head and Neck Surgery. 2018;144(8):712-717. PMID 30003226.
• Biswas R, Genitsaridi E, Trpchevska N, et al. Low Evidence for Tinnitus Risk Factors: A Systematic Review and Meta-analysis. Journal of the Association for Research in Otolaryngology. 2023;24(1):81-94. PMID 36380120.
• Board figures on this page: Claim Raven's read of every Board decision from 2021 to 2026 that it holds, and of every decision since 1992 for the longer view.